Editor’s Note: This is first in a two part series on health care reform.

While health care reform became federal law in March 2010, it’s soon to become effective. Still, most people are confused about it. Mike Ripley, vice president of Indiana Chamber of Commerce health care policy, said a study by the Kaiser Foundation showed “42 percent of the population doesn’t know it is the law and 50 percent have no clue how it impacts them.”

It was a major issue of the presidential campaign last November. While both parties generally agreed something had to be done to curb escalating health care costs, how to do so was the contentious issue. Overall, these laws were passed with the intent to help more people get affordable health care coverage and better care.

The Obama administration’s health care idea is what they are calling health care exchanges. Beginning Oct. 1, the “exchanges,” also called the Health Insurance Marketplace, will be open for the uninsured and to others who want to shop around for insurance. Most people will not be impacted as they have insurance through an employer or insurance company.

With that in mind, we talked with Tim Putnam, the president of Margaret Mary Health in Batesville, about health care reform and insurance. MMH is widely used by many Ripley County residents since it’s the closest hospital for the majority. (We also referred to well-known health care websites including healthcare.gov, Kaiser Foundation, and ihaconnect.org among others for information.)
Putnam has to keep up with health care and laws not only because he’s a major employer of over 500, but his business is health care. He wishes the government chose just one to reform--health care or health insurance. “It would have been less confusing for everyone if the insurance reforms were addressed separately from the actual health care delivery reforms.”

The Batesville hospital administrator believes the first things that happened with the law—those up to age 26 covered by parent insurance and removing the pre-existing condition—were the most positive. “As we move further into it, the more difficult decisions come into play, like the individual mandate. What if you can’t get affordable insurance and is the government going to fine you?”
Putnam said 8 to 10 percent of their patients are uninsured, which is a little lower than the state and national average. He noted Indiana hospitals lose $3 billion in uncompensated care annually, according to the Indiana Hospital Association study.
Who has to buy health insurance?

The Affordable Care Act requires all citizens to have health insurance, with some exemptions. How would that affect the hospital’s uninsured numbers and compensation data? Putnam says, “It depends on whether the state expands access to Medicaid. That’s the big thing. We don’t know yet.” Some people won’t have to buy insurance, including people with religious beliefs, undocumented immigrants, Native American tribes and prisoners. People whose income is below a certain level are also not required to buy insurance.

Where to buy?
The marketplace, called “exchanges” will be a state-run or federal-run website where many people can buy coverage. It will be available to anyone, the uninsured or those who want to buy it on their own. They will be able to compare and choose health plans offered by private companies and see if they are eligible for financial assistance. It will be opened Oct. 1, with coverage purchased effective Jan. 1.

Indiana is divided into 17 regions, with Ripley County being in Region 14. Carriers announced in July what products they will have on the exchange. Anthem will have a product in all but one region; MDWise will have all but Region 14. PHP carrier will have all but Regions 9, 12-16. Coordinated Care will be available for some districts. “If you go to the exchange in Region 14 you may have just one product to choose from,” Putnam said. An article in last week’s Indiana Business Journal pointed out that Anthem is the only carrier available throughout the state. That may change as more carriers enter the marketplace. He hopes more carriers join “so it will be competitive, which is better for the consumer,” Putnam commented.

Is Indiana expanding Medicaid?
Governor Mike Pence is not a proponent of the traditional Medicaid program. He has said he will consider expansion if the federal government lets Indiana use its Healthy Indiana Plan (HIP), a pilot Medicaid program the state has run since 2008 using waivers from federal rules. Pence likes HIP because it gives consumers more personal responsibility, and it’s less government intervention. He is also concerned about the sustainability of the federal program.

Earlier this month, Pence announced HIP will be extended a year as officials continue to negotiate with the federal government about using it to expand Medicaid. As part of the deal, Pence will lower the amount residents can earn before they qualify for HIP while pushing more residents into the federal health exchange. The deal buys more time for the state. The new limit for a single adult is earning $11,500 and those residents earning up to $22,300 and already enrolled in the program will have to seek private insurance.
More than 400,000 Hoosiers are uninsured.

According to the Kaiser Commission, Indiana would see a large decrease of uninsured if it expands Medicaid, dropping by 54.6 percent; however, if Indiana does not expand Medicaid, the state could lose out on free federal dollars. Putnam explains: “The federal government wants all the states to join, but the feds can’t force states to expand Medicaid. So they said ‘we’ll fund it, but it’s still a state decision.” He expects to know soon what Indiana will do.

Meanwhile, Putnam and others question the funding. If Indiana opts out, the state’s federal share of funds will be distributed to other states. Putnam explained, “The federal government wants to fund the expansion of the Medicaid program that has some major flaws; state leaders would rather use those funds to expand the needs of Hoosiers. There is a clear danger that if an agreement cannot be reached, Indiana will lose out on substantial federal dollars designed to provide health care for low income families who do not currently qualify for Medicaid.”

NextWe’ll continue the health care reform series and talk about services covered and penalties, among other concerns in next week’s newspaper.

Top school leader coming to career center

The Indiana Superintendent of Education Glenda Ritz will attend the regular board meeting of the Southeastern Career Center Nov. 13. Brad Street, the SCC superintendent, informed the board at the Sept. 11 meeting that Ritz agreed to attend. Street will give a presentation and focus on the career center’s growth, industrial partnerships and financial situation.

According to the unofficial minutes from the meeting, school attorney Larry Eaton said the changes in the law regarding the Common School Fund could help with dollars for future renovations. State Rep. Randy Frye is working with him on co-sponsoring a bill. Eaton mentioned it is to their advantage that the governor is pushing career and tech programs, and there’s been increased program support from manufacturers such as Honda and Cummins.

Susan Taylor, guidance counselor, gave a presentation about the growth of the center’s college connection night and open house. Six different representatives visited during the day and around 30 technical schools, colleges and businesses attended in the evening.
The event consists of an open house, an opportunity to meet instructors and visit classrooms. There was also a chili supper.
Taylor said the whole program is helpful to both parents and students.

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